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同切口固定近(同)平面胫腓骨双骨折

目的 总结同一切口完成近（同）平面胫、腓骨骨干双骨折内固定的手术方法。方法 2003年12月～2006年1月，采用胫骨钢板固定的外侧切口同时固定近平面闭合性胫、腓骨骨干双骨折31例，其中男23例，女 8例；年龄19～52岁，平均31岁。左侧17例，右侧14例。车祸伤18例，运动伤10例，摔伤3例。胫腓骨中段骨折10例，中下1/3骨折18例，中上1/3骨折3例。采用腓骨钢板固定18例，腓骨克氏针贯穿固定13例。结果 术后29例切口Ⅰ期甲级愈合，2例切口Ⅰ期乙级愈合。患者获随访3～24个月，3例胫骨骨折延迟愈合，1例发生长伸肌腱损伤，经2个月理疗和功能锻炼后治愈。无血管、神经损伤，效果满意 结论胫骨钢板固定的外侧切口同时固定近(同)平面胫、腓骨双骨折是一种简便、安全、实用、有效的内固定方法。

Clinical Observation of Using Minimally Invasive Percutaneous Plate Osteosynthesis Technology Combined with Locking Compression Plate in Treating Tibia and Fibula Fracture

目的　探讨应用经皮接骨板固定技术（MIPPO）结合锁定钢板（LCP）固定治疗胫腓骨骨折的疗效。 方法　2009年11月－2012年1月应用MIPPO技术结合LCP固定治疗胫腓骨干骨折62例。其中男42例，女20例；年龄16～85岁，平均45岁。骨折按AO分型：A1型10例，A2型3例，A3型3例，B1型18例，B2型8例，B3型4例，C1型10例，C2型5例，C3型1例。闭合骨折47例；开放骨折15例，根据Gustilo-Anderson分型，Ⅰ型8例，Ⅱ型6例，ⅢA型1例。伤后内固定时间3 h～10 d，平均6 d。 结果　开放骨折有3例伤口Ⅱ期愈合，其中1例伤口皮缘坏死，1例钢板部分外露经换药和清创减张缝合后伤口愈合，1例骨外露经皮瓣转移愈合；其余患者术后伤口均Ⅰ期愈合。62例均获随访，随访时间6～16个月，平均9个月。无感染、神经损伤、骨筋膜室综合征发生。术后2～4个月骨折均愈合。根据Johner-Wruhs疗效评价，优48例，良14例；开放性骨折15例中优10例，良5例。 结论　MIPPO技术结合LCP固定治疗胫腓骨干骨折，具有创伤小、骨折愈合快等优点。

Application of Taylor spatial frame combined with computer-assisted closed reduction in the treatment of tibiofibular fractures

ObjectiveTo explore the effectiveness of Taylor spatial frame (TSF) in the treatment of tibiofibular fractures and computer-assisted closed reduction.MethodsThe clinical data of 30 cases of tibiofibular fractures with soft tissue injury treated with TSF between January 2015 and September 2017 was retrospectively analyzed. According to different reduction methods, the patients were divided into control group (15 cases, open reduction in TSF external fixation) and trial group (15 cases, closed reduction in 1-3 days after TSF external fixation). There was no significant difference in the general data such as gender, age, affected side, cause of injury, AO classification of fracture, time from injury to operation between the two groups (P>0.05). The operation time, intraoperative blood loss, fracture healing time, and removal time of external fixator were recorded and compared between the two groups. At 3 months after removal of external fixator, the limb function was evaluated according to Johner-Wruhs criteria for evaluating the final effect of tibial shaft fracture treatment.ResultsBoth groups were followed up 9-16 months, with an average of 14 months. The operation time, intraoperative blood loss, fracture healing time, and removal time of external fixator in the trial group were significantly shorter than those in the control group (P<0.05). There were 2 cases of superficial infection of the external fixation (1 case in each group), 1 case of incision infection (control group), 1 case of delayed fracture healing (control group), 2 cases of traumatic arthritis (1 case in each group); no significant difference was found in the incidence of complications between the two groups (χ2=0.370, P=0.543). The wounds of soft tissue defect healed by the first intension in both groups. At 3 months after removal of the external fixator, the limb function results in the trial group were excellent in 3 cases, good in 9 cases, fair in 2 cases, and poor in 1 case, and the excellent and good rate was 80.0%; in the control group, the results were excellent in 3 cases, good in 8 cases, fair in 3 cases, and poor in 1 case, and the excellent and good rate was 73.3%. There was no significant difference in incidence of complication between the two groups (χ2=0.917, P=0.821).ConclusionCompared with intraoperative open reduction, postoperative computer-aided closed reduction can shorten the operation time, reduce the intraoperative blood loss, reduce the risk of long-term operation, avoid to destroy the blood supply of fracture end, shorten the healing time of fracture and the wearing time of stent, and alleviate the pain of patients after TSF treatment of tibiofibular fracture.

T 型外支架结合有限内固定治疗邻近胫骨远端关节开放性骨折

目的 总结T 型外支架结合有限内固定治疗临近胫骨远端关节开放性骨折的疗效。 方法 2002 年8 月－ 2006 年10 月收治邻近胫骨远端关节开放性骨折15 例，男10 例，女5 例；年龄21 ～ 63 岁。骨折按AO 标准分型，A1 型5 例，A2 型6 例，A3 型4 例。伤口按Gustilo 分型，Ⅱ型10 例，Ⅲ型5 例。伤后4 ～ 8 h 手术，平均5.2 h。急诊清创，腓骨骨折采用解剖钢板或1/3 管型钢板固定，胫骨骨折复位后螺钉或克氏针固定骨折，再用T 型外支架固定。 结果 术后切口Ⅰ期愈合11 例，Ⅱ期愈合4 例。15 例均获随访，随访时间8 ～ 24 个月，平均12 个月。X 线片示术后4 ～ 8 个月，平均6.2 个月均达骨性愈合。采用Johner-Wruhs 评分标准，优10 例，良4 例，差1 例，差的1 例为小腿内翻约5°。3 例针眼周围皮肤发红、渗液；5 例皮肤缺损或皮肤坏死，经不同方法处理均愈合；2 例骨折远断端固定针骨折愈合后松动并失效。 结论 T 型外支架结合有限内固定治疗邻近胫骨远端关节的开放性骨折有利骨折愈合，并发症少，具有操作简便、医源性损伤小、固定可靠、便于软组织处理、利于肢体早期功能锻炼的优点。

Ipsilateral Tibiofibular Fracture and Hip Fracture-Dislocation Associated with Posterior Cruciate Ligament Injuries:7 Cases Report

目的:对同侧胫腓骨骨折、髋关节骨折后脱位合并膝后交叉韧带损伤的创伤机制及诊断进行分析探讨。方法:对2007年1月至2008年6月收治的7例同侧胫腓骨骨折、髋关节骨折后脱位合并膝后交叉韧带损伤患者的临床资料、诊治经过和随访结果进行总结分析。结果: 胫腓骨开放性骨折3例(42.9%),闭合性骨折4例(57.1%);髋关节均有后脱位,其中伴有髋部骨折5例(71.4%)。膝后交叉韧带实质部断裂4例(57.1%),胫骨止点撕脱骨折3例(42.9%)。7例患者获平均14.7个月(12～18个月)随访。Lysholm膝关节功能评分术后6月95.8±3.71,术后12月97.6±2.7。结论:明确同侧胫腓骨骨折、髋关节骨折后脱位合并膝后交叉韧带损伤的创伤机制,全面、准确、系统的问诊查体和完善的辅助检查是早期确诊、提高疗效的关键。

APPLICATION OF ONE STAGE VACUUM SEALING DRAINAGE COMBINED WITH BI-PEDICLE SLIDING FLAP TRANSPLANTATION FOR OPEN TIBIOFIBULAR FRACTURE AND SOFT TISSUE DEFECTS OF THE LOWER LEG

ObjectiveTo evaluate the effectiveness of one stage vacuum sealing drainage (VSD) combined with bi-pedicle sliding flap transplantation in repairing open tibiofibular fracture and soft tissue defects of the lower leg. MethodsTwenty-five patients with open tibiofibular fracture and soft tissue defects of the lower leg were treated by VSD combined with bi-pedicle sliding flap transplantation between January 2012 and July 2014. There were 18 males and 7 females, aged 12-65 years (mean, 35.2 years). The injury causes included traffic accident injury (20 cases), falling injury from height (3 cases), and heavy pound injury (2 cases). The left side was involved in 14 cases, the right side in 8 cases, and both sides in 3 cases. According to Gustilo classification, injury was rated as type II (6 lower extremities), type III a (19 lower extremities), and type III b (3 lower extremities). The anterior tibial defect area after debridement ranged from 6 cm×3 cm to 12 cm×5 cm. The course of injury and admission was 1-18 hours (mean, 4.5 hours). An anterior tibial bi-pedicle sliding flap of 24 cm×6 cm to 48 cm×8 cm was designed to cover the wound and tibia fracture was fixed with minimally invasive internal fixation. After suturing the anterior tibial wound without tension, the flap was transferred forward. The exposed fibula was fixed with reconstruction plate. The remained wound was covered by VSD. Continuously antibiotic saline irrigation was applied postoperatively. After 15 days, the VSD dressing was removed and free skin graft was used to cover the remained wound. ResultsAfter the VSD dressing was removed, the wounds and tension-reduced wound of 18 lower extremities completely healed. Unhealing wounds were covered by skin graft in 9 lower extremities. Infection occurred in 1 lower extremity and was cured after treated with antibiotics. All the wounds healed and flaps survived. The patients were followed up 6-24 months (mean, 18 months). The fractures union was confirmed by X-ray and the average union time was 3.2 months (range, 2.5-5 months). ConclusionThe application of one stage VSD combined with bi-pedicle sliding flap transposition is a simple and safe treatment regimen for Gustilo type II-IIIa open tibiofibular fracture and soft tissue defects of the lower leg. It has the advantages of few complications and low costs, short hospitalization, and good effectiveness.

胫腓骨骨折术后感染的治疗分析

目的 总结胫腓骨骨折术后感染的治疗方法，以提高治疗效果。 方法 2004年4月－2008年2月收治胫腓骨骨折术后感染患者45例，均存在不同程度骨外露或窦道形成。男39例，女6例；年龄22～62岁，平均32.5岁。确诊感染时间为骨折内固定术后1周～1年，平均3.5个月。16例骨折稳定，29例骨折不稳定或存在骨缺损。根据感染程度、组织缺损及骨折稳定情况，单独或联合采用更换骨折固定方式、骨与软组织同步延长、侧孔灌洗管灌洗术、封闭式负压引流进行治疗。 结果 45例均获随访，随访时间12～28个月，平均20个月。29例骨折不稳定者中27例骨折于治疗后4～11个月愈合，平均6.6个月；2例6个月后骨折无愈合迹象，感染无复发，经实施外固定架固定加自体髂骨移植术后5个月骨折愈合。治疗后感染复发2例，经再次清创、灌洗治疗后治愈。 结论 对胫腓骨骨折术后感染，应根据具体情况实施治疗，以最大限度满足治疗感染、修复缺损、促进骨折愈合的多重要求。

高原地区交锁髓内钉治疗胫腓骨骨折骨不愈合

REPAIR OF OPEN FRACTURES OF BOTH TIBIA AND FIBULA COMPLI CATED BY SOFT TISSUE DAMAGE WITH FASCIOCUTANEOUS FLAPS

Between 1988 and 1991,27 cases of open fractures of shank bones complicated by soft tissue defect were repaired with fasciocutaneous flaps. The wound surfaces in 11 cases were closed in the first stage and in 16 cases the repair was delayed. The wounds of all the 27 cases had good healing, In fasciocutaneous flaps the blood supply was sufficient and this contributed to subsequent healing. The operation was simple, regardless of the postion of the wound and not damaging the blood vessels. An accurate estimation of the degree of contusion of the soft tissues surrounding the wound was prerequisite to select immediate transposition of fasciocutaneous flapsor delayed transposition.

TREATMENT OF NONUNION OF TIBIA WITH SUPERFICIAL PERONEAL VASCULAR FASCIA PEDICEL TIBIOFIBULAR PERIOSTEAL FLAP

Objective To investigate the surgical treatment method and the curative effect of tibial nonunion with superficial peroneal vascular fascia pedicel tibiofibular periosteal flap. Methods From January 1996 to December 2008, 18 cases of tibial nonunion were treated with superficial peroneal vascular fascia pedicel tibiofibular periosteal flap, interlockingintramedullary nail ing and cancellous bone graft of distal tibial. There were 14 males and 4 females, with an average age of 32.5 years old (range, 24-67 years old). Fracture site was middle in 10 cases and distal in 8 cases. Primary injury cause included 12 cases of traffic accident and 6 cases of bruise. The tibial nonunion reasons were manual reduction and plaster immobil ization in 8 cases, small spl int immobil ization in 4 cases, intramedullary nail fixation in 2 cases (no bone graft), plate fixation in 4 cases (including 3 cases of plate fixation and free il iac bone graft). Nonunion occurred after the first surgery. The time from nonunion to operation was 8 to 16 months, with an average of 10.5 months. The size of periosteal flap was 7 cm × 5 cm and distal tibial cancellous bone graft volume was 5-10 g. Results All incision achieved heal ing by first intention after operation without flap necrosis and infection. All patients were followed up 6-36 months with an average of 20.8 months. All tibial nonunion healed 5-7 months after operation. According to Johner-Wruh scoring, the results were excellent in 14 cases, good in 3 cases, and fair in 1 case; the excellent and good rate was 94.4%. Conclusion Superficial peroneal vascular tibiofibularfascia pedicel tibiofibular periosteal flap and interlocking intramedullary nail ing can attain good results in treating nonunion of tibia and fibula because of being stable internal fixation and promoting the heal ing of nonunion.